12th ESOU: Focus on multidisciplinary teamwork and training

09 March 2015

Close to 900 urologists, oncologists and other medical specialists gathered in Munich on January 16 to 18 January to discuss how to improve treatment outcomes in urological cancers during the 12th EAU Section of Oncological Urology (ESOU) Meeting.

The annual ESOU meeting highlights advances and the latest developments in onco-urology through education and plenary meetings where controversies are addressed. The sessions ranged from heated debates on techniques to showcasing collaboration among disciplines for improving treatment outcomes.

Personalised medicine and MRI advances

“The issue of the year is multi-disciplinarity. For onco-urologists, the future lies in teamwork. We must work together with pathologists, radiotherapists, radiologists and medical oncologists,” said ESOU chairman Maurizio Brausi (IT).

The patient is central to these developments in light of the growing importance of personalised medicine. The idea that each patient should have a course of treatment tailored to individual needs requires an

entire team of different oncological specialities, according to Brausi. As Professor Reinhard Büttner (DE) explained, personalised medicine is already a reality in urological cancers, especially in bladder and prostate treatment.

Büttner stressed the importance of data from different sources. In his view, personalised cancer therapy treatment requires “a strong basic, diagnostic, and clinical pathology, as well as interdisciplinary diagnostics in specialised centres where there is a team of different specialists that can provide the information from different angles.”

The first session included presentations regarding the use of MRI, particularly multiparametric MRI (mpMRI) in the diagnosis of prostate cancer. In the past, detection of cancer tumours was considered sufficient, but as technology evolved, mpMRI has become an interesting tool to detect clinically significant cancers, as underscored by Bob Djavan (AT) in his lecture.

However, for Jonas Hugosson (SE) it could still be too early to dismiss systematic biopsy, particularly when

up to 15% significant PCa has been identified at radical prostatectomy in patients with negative MRI. There are other hurdles to MRI adoption since it requires having a dedicated radiologist and an interdisciplinary setting which are crucial for the best diagnosis and decision-making. Although this can be found in interdisciplinary centres, there are only a few in Europe and they are unevenly distributed and with limited coverage. Besides, the high technology costs make it less available than other diagnostic methods. However, as technology advances, the possibilities and capabilities of MRI are gaining ground and it is relevant to follow future developments.

A recurring debate: open or laparoscopic?

The debate regarding open and robotic surgery, particularly for prostate cancer, continues. While it has been established that oncological outcomes are not superior in robotic surgery, functional outcomes can be better. One area where the advantages of a minimally-invasive approach may prove more beneficial is in cases of complicated reconstruction surgery, said Axel Heidenreich (DE).

For Herbert Lepor (USA), the technique used is much less relevant than the experience of the surgeon. Thus, the

debate should focus on training of surgeons, regardless of technique used. While robotics is expensive and not widely available in many parts of Europe, as technology evolves perhaps robotic surgery will become more widespread which requires trained doctors. In line with these developments, and to strengthen the ESOU’s educational goals, the 2015 edition also featured Hands-on Training (HoT) sessions with simulators which provided an introduction into standardised surgical steps in robot-assisted procedures.

Training for the future: STEPS sessions

ESOU2015 marked the 5th anniversary of the successful “Sessions To Evaluate ProgresS” in the management of urological cancers (STEPS). This partnership between ESOU, IPSEN and the EAU provides the opportunity for around 15 and 20 participants to engage with world-class experts in urological cancers during the ESOU meeting. To date, 78 fellows from 22 different countries have participated and gained access to a unique network, and have received expert advice in difficult cases and how to improve strategic thinking regarding treatment options.

Clinically relevant presentations

Heidenreich reiterated that in line with ESOU’s main goal to strengthen education and knowledge sharing, the organising committee invites doctors who are not only research experts but are also practising physicians who confront clinical challenges and complications in their daily routine.

“This year’s scientific meeting was based on clinical decision-making processes. It covered quite remarkably the unmet needs of urologists interested in uro-oncology and what they see in daily practice,” said Heidenreich.

The three-day event in Munich ended with the award ceremony with Professor Imre Romics (HU) receiving the honour for lifetime achievement and his commitment to improve urological practice in his home country and beyond.

In his closing remarks, Brausi underscored the annual meeting will pursue its aim to bring together various oncological specialities in a bid to enhance networking and collaboration. He added that mutual confidence underpins not only the success of multidisciplinary teams but is also crucial to the diagnosis and treatment of urological cancers.